双切口克氏针及外侧可吸收张力带内固定治疗儿童肱骨髁上骨折

目的：探讨双侧克氏针结合外侧可吸收张力带内固定治疗儿童肱骨髁上骨折的临床疗效。方法：2006年至2010年采用双侧切口切开,交叉克氏针并可吸收张力带内固定治疗82例儿童肱骨髁上骨折,男53例,女29例;年龄5～12岁,平均7岁。根据骨折临床愈合后肘关节屈伸功能及肘部提携角结果,按Flynn评定标准综合评定疗效。结果：82例均获随访,时间0.5年,肘关节屈伸活动受限（2.8±3.7）°,提携角（12.7±2.2）°。依据疗效评定标准,优80例,良2例。结论：采用双侧切口交叉克氏针并可吸收张力带内固定治疗儿童肱骨髁上骨折,能早期进行肘关节功能锻炼,具有创伤小、固定牢固、恢复快的特点,是目前手术治疗儿童肱骨髁上骨折较理想的方法。     

张力带钢丝内固定治疗儿童肱骨髁上骨折疗效分析

目的 :分析讨论张力带钢丝内固定治疗儿童肱骨髁上骨折的临床效果。方法 :回顾分析 5 6例采用张力带钢丝内固定治疗儿童肱骨髁上骨折 ,随访 1～ 5年 ,平均 2 .5年。结果 :5 6例病人全部随访 ,均获骨性愈合 ,除 2例轻度肘内翻 (<5°) (3.6 % )外 ,无手术并发症发生 ,肘关节功能优良率达 96 .4 %。结论 :张力带钢丝内固定治疗儿童肱骨髁上骨折 ,具有操作简单 ,固定牢固 ,无需外固定 ,早期功能锻炼 ,关节功能恢复良好 ,是内固定治疗肱骨髁上骨折防止肘内翻的有效方法。     

克氏针张力带内固定治疗儿童肱骨髁上骨折

肱骨髁上骨折是儿童肘部最常见的骨折,治疗方法较多,疗效差别也较大.自2000年4月～2005年11月,笔者采用外侧切口进针克氏针张力带内固定治疗儿童肱骨髁上骨折38例,疗效满意.     

改良穿针并外张力带固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的:探讨改良穿针并外张力带固定治疗GartlandⅢ型儿童肱骨髁上骨折的临床疗效。方法:自2009年2月至2010年11月采用肘外侧切口、改良穿针(内外髁交叉并外髁辅助穿针)并外侧外张力带固定(交叉针尾相互钩绕)法治疗GartlandⅢ型儿童肱骨髁上骨折79例,其中男47例,女32例;年龄2.5～14岁,平均8.7岁。受伤至手术时间2h～8d。记录手术前后肘关节活动度及提携角,按照Flynn评定标准评定疗效。结果:61例获得随访(18例失访),时间6～30个月,平均13.5个月。根据Flynn评定标准:优53例,良7例,可1例。结论:采用外侧小切口复位后行改良穿针并外侧外张力带固定治疗儿童肱骨髁上骨折具有固定牢固、恢复快、并发症少的特点,是治疗儿童肱骨髁上骨折较理想的方法之一。     

克氏针张力带钢丝内固定治疗儿童肱骨髁上骨折

目的:探讨儿童肱骨髁上骨折的治疗方法及克氏针"8"字张力带钢丝固定治疗儿童肱骨髁上骨折的临床效果。方法:取肘后切口,行双"8"字张力带钢丝克氏针交叉内固定治疗儿童肱骨髁上骨54例,骨折类型全部为闭合性伸直型损伤。结果:按陆裕朴[1]评定标准,优良率96%,结论:"8"字张力带钢丝克氏针交叉内固定治疗儿童肱骨髁上骨折,固定牢靠,关节功能恢复好,是治疗小儿肱骨髁上骨折的有效方法。     

外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折

目的介绍采用外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折的方法及临床疗效。方法采用该方法治疗儿童重度肱骨髁上骨折48例。结果随访4～73个月,平均36个月。本组骨折复位良好,骨折全部愈合,功能恢复良好,1例轻度肘内翻(小于5°)。结论外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折,手术创伤小,并发症少,固定牢固,肘关节功能恢复良好。     

两种手术方法治疗儿童重度肱骨髁上骨折的疗效比较

目的比较两种手术方法治疗儿童重度肱骨髁上骨折的疗效。方法将110例肱骨髁上骨折患者随机分为改良组和对照组各55例,改良组内外侧联合小切口克氏针钢丝张力带内固定,对照组交叉克氏针内固定,观察两组术后疗效。结果改良组平均骨折愈合时间比对照组提前15 d,肘关节功能恢复较好,并发症发生率较少,两组比较差异有统计学意义(P<0.05)。结论肘内、外联合小切口克氏针钢丝张力带固定较传统手术方式好,是治疗肱骨髁上骨折的一种有效方法。     

可吸收张力带在肘内翻截骨矫形术中的应用

自1998年1月～2003年1月采用可吸收线和可吸收螺钉或棒形成可吸收张力带固定肱骨髁上截骨两端,治疗15例肘内翻,疗效满意。     

带螺纹克氏针内固定治疗儿童肱骨外髁骨折

目的观察应用带螺纹克氏针内固定治疗儿童肱骨外髁骨折的治疗效果,对比其他治疗方法,提高对儿童肱骨外髁骨折治疗的认识。方法总结分析本院近年来运用带螺纹克氏针内固定治疗儿童肱骨外髁骨折15例,男11例,女4例;年龄4～9岁,平均6.3岁,术后随访1年。结果所有病例均在术后4～6周骨性愈合,肘关节功能恢复良好。随访1年未发现有骨折再移位、肘外翻畸形、骨坏死、创伤性关节炎、骨化性肌炎的发生,疗效满意。根据肘部外形、活动功能和并发症分为优、良、差3个等级,其中优12例,良3例,优良率为100%。结论对有移位的儿童肱骨外髁骨折早期手术切开、精确复位、可靠固定,有利于减少各种畸形与并发症的发生。带螺纹克氏针内固定治疗儿童肱骨外髁骨折,具有复位准确、固定牢靠及并发症少等优点,是目前治疗儿童肱骨外髁骨折较为理想的方法。     

骨片钉内固定治疗儿童肱骨外髁骨折19例

目的探讨儿童肱骨外髁骨折骨片钉内固定的适应症及疗效。方法本院2002年1月～2005年12月收入住院的儿童肱骨外髁骨折19例,先采用麻醉下手法整复,然后对移位>2～3mm的病例行切开复位骨片钉内固定。结果19例儿童肱骨外髁骨折均经切开复位骨片钉内固定,术后随访时间6～24个月,平均16个月,全部骨性愈合,除1例术后6周X线检查发现骨片折断外,未有其它并发症发生,优良率达94.7%。结论骨片钉内固定法对治疗儿童肱骨外髁骨折具有操作简单,固定可靠,骨折愈合率高,对骨骺影响小,值得推广。     

切开内固定治疗儿童肱骨外髁陈旧性骨折

目的探讨传统克氏针与可吸收螺钉治疗儿童肱骨外髁陈旧性骨折的疗效。方法回顾性分析2004年9月~2006年9月收治的儿童肱骨外髁陈旧性骨折20例,8例采用克氏针、12例采用可吸收螺钉内固定。结果平均随访1.2(1~1.5)年,疗效评定:优19例(克氏针固定7例,可吸收螺钉固定12例);可1例(克氏针固定)。结论可吸收螺钉治疗儿童肱骨外髁陈旧性骨折效果好,值得推广。     

Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children

Objective： To evaluate the value of ultrasonography in non-isplaced and mini-displaced humeral lateral condyle fractures in children.
Methods： Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography. The fracture line through the joint surface was visualized by ultrasonography in 6 case, in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients＇ or their parents＇refusal. In the remaining 3 children, ultra- sonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted.
Results： The average follow-up period was 8 months. The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treat-ment and another child who received percutaneous pinning. The elbow function and fracture healing were good in cases received closed reduction and percutaneous pinning. Among the three cases who refused to receive closed reduction and internal fixation, re-displacement occurred in 1 case and delayed union in 1 case. All three cases receiving conservative treatment had good results both in elbow function and fracture healing.
Conclusion： High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved. For these cases, arthrography or magnetic resonance imaging is unnecessary.     

Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children

The authors assessed whether a period of 3 weeks, rather than the commonly used 6 weeks, of smooth Kirschner wire fixation and cast immobilization of the elbow was sufficient to achieve union of displaced fractures of the lateral humeral condyle treated by open reduction. The authors found only one nonunion in a case series of 104 children treated with 3 weeks of fixation. Infections occurred in two children (2%). Late review of 63 children (61%) showed abnormalities of elbow shape in 28 (44%) and wide surgical scars in 43 (68%). The abnormalities of elbow shape were mainly due to overgrowth of the lateral humeral condyle, to the formation of excessive amounts of bone over the outer surface of the condyle, or both. The authors' findings indicate that a period of 3 weeks of smooth Kirschner wire fixation and elbow immobilization is sufficient to achieve healing in most displaced fractures of the lateral humeral condyle treated by open reduction. The findings also indicate that new strategies are needed to reduce the occurrence of overgrowth of the lateral condyle, excessive formation of bone over the condyle, and wide scars.     

克氏针张力带治疗儿童陈旧肱骨外髁骨折疗效观察

目的：初步观察克氏针钢丝张力带对儿童肱骨外髁陈旧骨折的疗效。方法：选取1995年1月至2007年1月我院收治的98例儿童陈旧肱骨髁骨折,按Jakob分型,其中JakobII型37例,JakobIII型61例,行切开复位克氏针钢丝张力带内固定术。观察克氏针钢丝张带治疗儿童陈旧性肱骨外髁骨折的治疗效果,分析并发症发生率与分型有无相关。结果：随访3—5年,平均4．2年,术后6．8周骨折临床愈合。根据Hardacre标准判断疗效,II、III型骨折优良率分别为95％（35／37）、85％（52／61）,总优良率为89％（87／98）。并发症发生率为24．5％（24／98）,II型为10．8％（4／37）,III型为32．8％（20／61）,II、III型骨折并发症发生率在统计学上有显著差异（P〈O．05）。结论：切开复位克氏针钢丝张力带内固定能有效重建肘关节外观和功能,对JakobII、JakobIII型骨折治疗均能取得满意效果。III型骨折的并发症发生率明显高于II型骨折。     

C臂引导下双入路微创治疗儿童肱骨髁上骨折

目的探讨C臂引导下儿童肱骨髁上骨折行双切口入路微创内固定术的可行性及疗效。方法 10例儿童肱骨髁上骨折患者,取肘外侧髁切口为主内侧髁切口为辅的＂一主一辅＂双切口入路,C臂引导下行肱骨髁上骨折复位交叉克氏针内固定。结果本组均获随访,平均3.5（2-5）个月。术后3 d复查X线显示均达解剖复位。本组无术中神经损伤及切断肱三头肌,无感染及术后内固定松动移位发生。骨折均在12周内达骨性愈合,其中6周愈合4例,8周愈合5例,12周愈合1例,无一例骨化性肌炎。肘关节功能按Cassebaum标准评定疗效,优8例,良2例,优良率100%。恢复良好。结论该切口术式对伸肘结构损伤小,肘关节功能恢复良好,并发症少,效果优良。     

Posteromedial dislocation of the elbow with lateral condyle fracture in children

Posteromedial dislocation of the elbow in children is an extremely rare injury. The current study describes four boys with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. The patients ranged in age from 6 to 12 years (average age, 9 years 6 months). Closed reduction of the elbow dislocation and open reduction of the lateral humeral condyle fracture with fixation by Kirschner wires by a lateral approach was done in each patient. This was followed by 4 weeks immobilization wearing a long-arm cast. There were three excellent results and one good result. Healing and return of normal function occurred in all but one patient who had minor loss of full extension. Average duration of followup was 7 years 6 months (range, 3-13 years). Dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle can be treated by closed reduction of the elbow dislocation and open anatomic reduction and fixation of the lateral condyle fracture with good results.     

肘关节镜下复位经皮内固定治疗儿童肱骨外髁骨折

目的肘关节镜下复位经皮内固定治疗儿童肱骨外髁骨折的疗效。方法将64例肱骨外髁骨折患儿按入院先后顺序分为两组:切开复位组32例,采用切开复位内固定治疗;关节镜组32例,采用肘关节镜下复位经皮内固定治疗。结果 64例患儿术后获得12~24个月的随访,平均17.15±5.12个月。关节镜组及切开复位组术中出血量分别为40.5±8.5 mL、110.5±15.5 mL;切口长度分别为0.95±0.30 cm、6.95±1.50 cm;术后第3天视觉模拟疼痛评分(VAS)分别为3.85±1.35、7.85±2.05分,两组间差异有统计学意义。根据Mayo肘关节功能评分切开复位组优良率为84.4%,关节镜组优良率为96.9%,两组间差异有统计学意义。术后切开复位组肘关节内外翻畸形3例,钉道感染5例;关节镜组只有1例肘关节内外翻畸形,没有钉道感染病例。两组间术后并发症差异有统计学意义。结论肘关节镜下复位经皮内固定治疗儿童肱骨外髁骨折具有创伤小、并发症少等优点。     

可吸收螺钉在关节内骨折的应用

目的探讨可吸收螺钉内固定治疗关节内骨折的临床效果. 方法回顾性分析1999年6月～2004年6月的69例关节内骨折患者,其中踝关节骨折42例,肱骨内外髁骨折19例,髋臼骨折8例,均行可吸收螺钉内固定手术. 结果平均随访19个月(4个月～5年),所有病例骨折均在伤后12周内愈合,关节活动无明显异常,优良67例,可2例. 结论可吸收螺钉内固定具有操作简便,固定可靠,临床效果良好等优点,避免了患者需再次手术取出内固定物的痛苦和负担.     

Die Behandlung der Condylus-radialis-humeri-Fraktur im Kindesalter

Objective

Surgical treatment of lateral humeral condyle fractures with reduction and retention in order to prevent lasting malalignment, pseudarthrosis, and joint instability.

Indications

Absolute: fractures with a complete dislocation or those in which plaster-free control X-ray on day 4 shows a gap of > 2 mm. Relative: complete fractures of the lateral humeral condyle which demonstrate a dislocation ≤ 2 mm on follow-up.

Contraindications

Incomplete, so-called hanging fractures of the lateral humeral condyle without notable secondary dislocation on follow-up.

Surgical Technique

Open reduction of the lateral humeral condyle via a lateral approach to the elbow joint. In smaller children (< 5 years of age) fixation with Kirschner wires. In older children (≥ 5 years of age) or in cases requiring compression radial screw fixation is recommended. In all cases, suture repair of the periosteum is advisable.

Postoperative Management

Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3–4 weeks postoperatively. Implants are removed following consolidation (confirmed by X-ray) after approximately 2–3 months. Routine physiotherapy is normally not required.

Results

From January 1, 1999 to December 31, 2006, 85 children with a median age of 6.1 years had lateral condyle fracture of the humerus treated. 47 patients underwent surgery. Of these, 31 were treated with a combination of screw and Kirschner wire fixation, 13 with a single screw, and in three cases, the fracture was fixed with Kirschner wires only. After a median of 8.6 weeks (range, 5.0–17.1 weeks), implants were removed. Median follow-up time was 6 months (range, 2–50 months). There were no late complications in this series (e.g., lack of consolidation, pseudarthrosis). In five cases, hyposensitivity of the skin above the proximal aspect of the radial bone was noted postoperatively. This problem was solved in all instances within the following 6 months. A telephone survey with a response rate of 87% (74 patients) was undertaken in September 2007. Three children noted a minimal deficiency in strength of the injured arm in comparison to the contralateral extremity. One of these children additionally stated a minor flexion deficit of the elbow already present at the last follow-up in the outpatient clinic, which showed no progress. None of the patients had to be referred back to the outpatient clinic because of persistent problems and/or unacceptable results.